Every finding on record at Aveeva Hospice

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the organization did not ensure the initial comprehensive assessment was completed no later than five (5) calendar days after the election of hospice care. Clinical Record 6: This patient elected hospice care on 02/17/2024. The initial nursing assessment dated 02/17/2024 indicated the need for a spiritual assessment to be completed by the hospice chaplain. The chaplain completed the initial spiritual assessment on 02/24/2024, seven (7) calendar days after the election of hospice care. During a joint clinical record review on 02/28/2024 with the Nurse Practitioner (NP)/Director of Patient Care Services (DPCS), the clinical record was reviewed, and it was acknowledged by the NP/DPCS that the spiritual assessment was "completed late".

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) applicable clinical records reviewed for patients receiving hospice aide services, the organization did not ensure complete written care instructions for the hospice aide were prepared by the registered nurse. Clinical Record 3: This patient elected hospice care on 12/01/2023. A new physician order 02/14/2024 stated in part, "Foley Catheter (16fr/5 ml) attached to drainage bag for urine retention change as needed (PRN), may replace if dislodged, occluded, or leaking". A licensed vocational nursing note dated 02/14/2024 indicated in part, "Foley inserted sterile technique completed 16 fr/ 5 ml urine dark yellow 1500cc of urine noted in bag, IDT/CM made aware." Subsequent RN visits did not include documentation of an updated aide plan of care to include instructions for the aide on how to handle the indwelling catheter when providing personal care for the patient. During the daily wrap up meeting with the Administrator and Nurse Practitioner/Director of Patient Care Services on 02/26/2024, it was reviewed and agreed that the hospice aide plan of care had not been updated to include instructions related to the foley catheter.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) applicable clinical records for patients receiving hospice aide services, the organization did not ensure that the hospice aide was supervised by a registered nurse making an on-site visit to the patient's home no less frequently than every fourteen (14) days. Clinical Record 14: This patient elected hospice services 12/01/2023 and was receiving hospice aide services twice weekly as ordered per the aide plan of care dated 12/01/2023. The RN performed aide supervision on 01/08/2024 then on 01/23/2024, 15 days from the prior supervisory visit. During the daily wrap up meeting on 02/27/2024 with the Administrator and Nurse Practitioner/Director of Patient Care Services, the clinical record was reviewed, and it was agreed that the record was missing the registered nurse supervision of the hospice aide at least every fourteen (14) days.